Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Occurrence of fever in a patient with liver cirrhosis should suggest the following: 1. Endotoxemia. Endotoxins are normally present in portal blood; in hepatic cirrhosis they are insufficiently cleared by the liver and their presence can be demonstrated in the systemic circulation by the "limulus test". Fever is one of the many consequences ascribed to the presence of endotoxins in the blood. 2. Infections. Cirrhosis and alcoholism (which often accompanies it) impair host defenses against bacteria and other organisms. Thus, infections are actually more frequent in hepatic cirrhosis as is shown by the example of bacterial endocarditis. Spontaneous bacterial peritonitis must be searched for carefully when ascites is present. 3. Alcoholic hepatitis. This diagnosis is established histologically. The usual symptoms, occurring with variable incidence, include anorexia, nausea and vomiting, abdominal pain, fever and jaundice in the presence of hepatomegaly, leukocytosis and an elevated SGOT. Differential diagnosis from obstructive jaundice and a severe prognosis without alcohol abstinence make early diagnosis mandatory. Its evolution in cirrhosis can be astonishingly rapid. In the absence of hepatic encephalopathy, corticosteroids do not appear to be recommended. 4. Hepatoma.
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PMID:[Fever and liver cirrhosis]. 22 38

The role of liver size in drug metabolism was investigated in 34 chronic alcoholics and 28 controls by comparing antipyrine half-life with biopsy content and total amount of hepatic cytochrome P-450 (P-450) and liver weight. Liver size was significantly greater in alcoholics than in controls. Total P-450 was increased and antipyrine metabolism was enhanced in alcoholics with normal histology of the liver. In subjects with alcoholic hepatitis or cirrhosis, the antipyrine half-life was prolonged and P-450 was decreased. Alcoholics with fatty liver had a reduced P-450 content, but the total amount of P-450 and the antipyrine half-life were normal. The results demonstrate in alcoholics that an enlarged liver of normal histological appearance is associated with enhanced drug metabolism. In subjects with fatty liver the drug metabolizing capacity per unit weight of liver is often impaired, but the increase in liver size leads to undisturbed total oxidizing capacity and normal in vivo metabolism. In alcoholic hepatitis drug metabolism is impaired in spite of hepatomegaly. In cirrhosis the enlargement of the liver appears to compensate for the decreased P-450 content resulting in only slightly decreased total P-450, and the severly impaired in vivo drug metabolism may be due to derangement of blood flow.
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PMID:Liver size and indices of drug metabolism in alcoholics. 63 35

Acute alcoholic hepatitis is an anatomical (fatty liver with sclerosing hyaline necrosis) and a clinical (hepatomegaly with a variety of symptoms of hepatic failure) entity arising out of chronic alcoholism, and of a typically 'pre-cirrhotic' state. Although fatal in 25% of acute cases due to failure of homeostasis, it often leaves a centrilobular scarring necrosis which in more than 60% of cases progresses to nodular cirrhosis. Continued alcoholism worsens the prognosis. Alcoholic hepatitis may be confused with acute abdominal catastrophes or with a hepatoma. The characteristic Mallory bodies found on liver biopsy are found rarely in non-alcoholic hepatitis. There is no effective treatment for this disease except reduction of alcohol intake; indeed, the disease may become self-perpetuating.
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PMID:[Acute alcoholic hepatitis]. 92 58

The authors report the cases of 4 patients with heavy chronic alcoholic intake who presented with hepatomegaly and jaundice without obvious hepatic failure and who died rapidly. In all 4 cases, histological examination of the liver showed massive microvesicular and macrovesicular steatosis involving approximately 100% of hepatocytes and, in 2 cases, minimal lesions of alcoholic hepatitis. Histochemical study, performed in 3 cases, showed that steatosis was constituted of triglycerides only, and that hepatic glycogen was completely depleted in 2 of 3 cases. No obvious cause of death was found in these 4 patients. Shortly, before their death, the 4 patients had increased their ethanol and decreased their food intake. The authors suggest that death as well as microvesicular steatosis could have be due to acute mitochondrial dysfunction.
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PMID:[Severe hepatic steatosis: a cause of sudden death in the alcoholic patient]. 147 9

The drinking behaviour of 95 consecutive men subjected to medicolegal autopsy in Helsinki was studied by interviewing a relative or friend of the deceased. Sufficient data for estimating the daily alcohol dose were obtained in 61 (64%) of the cases. Of these men, 21 (34%) were reported to drink at least an average of 80 g of alcohol daily. The validity of post-mortem alcohol reports was assessed by comparing the occurrence of alcohol-related diseases, toxicological data as well as the cause and manner of death with the reported alcohol consumption. Men whose reported daily alcohol consumption exceeded 80 g (mean 230 g) differed from men reported to drink less than 10 g (mean 3 g) in their more common incidence of positive post-mortem alcohol test (P less than 0.0005), fatty liver (P less than 0.001), enlarged liver (P less than 0.01), alcoholic hepatitis (P less than 0.05), chronic pancreatitis (P less than 0.01), and in their lower rate of death from cardiovascular diseases (P less than 0.05). The present results indicate that interviews with relatives or friends provide reliable data on the drinking behaviour of the deceased. At autopsy, the most sensitive tests coinciding with high consumption of alcohol in post-mortem alcohol reports but not with each other were positive post-mortem blood alcohol and the occurrence of fatty liver.
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PMID:Validity of post-mortem alcohol reports. 233 92

This review article is mainly concerned with the incidence and pathogenesis of alcohol-induced liver diseases. Clinically the most relevant symptom is a hepatomegaly. During the course of the disease there is to state progression to alcoholic hepatitis with increasing jaundice. The laboratory values show different patterns; severe courses develop progression to a fulminant hepatitis. The diagnostic approach includes exact patient's medical history, clinical and laboratory investigations, followed by a step-wise diagnostic procedure including histology. Therapeutically the main approach is a diet, in case of malnutrition substitution of vitamins and only rarely the need of corticosteroids and/or anabolic steroids. Prognosis and long-term course of alcoholic-induced liver disease depend mainly on the severity of the disease and the consequent alcohol-free diet.
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PMID:[Alcohol-induced liver diseases]. 265 33

Nonalcoholic steatohepatitis (NASH) refers to an alcoholic hepatitis-like histologic pattern found in nonalcoholic patients. A review of 543 liver biopsies diagnosed as alcoholic hepatitis yielded 49 cases of NASH. The patients were commonly middle-aged women who were obese and often diabetic. NASH was usually discovered because of abnormal liver function tests or hepatomegaly noted during evaluation of other medical problems. Histologic examination revealed the same spectrum of changes found in alcoholic hepatitis, including cirrhosis in eight patients. Follow-up information was available for 39 patients after an average length of 3.8 years. Only one patient developed hepatic decompensation or died with liver failure or portal hypertension. Repeat histologic material was available for 13 patients after a mean 3.5 years of follow-up. Five patients showed progression of fibrosis, with cirrhosis developing in two, but the other eight patients demonstrated little morphologic change. These findings indicate that NASH is, in general, a clinically mild and biologically low-grade condition, but with the potential to progress and evolve into cirrhosis in some patients. The factors promoting progression are unclear.
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PMID:Nonalcoholic steatohepatitis: a study of 49 patients. 265

A retrospective study was designed to analyse the mode of presentation, clinical signs, haematological, biochemical and histological features in 46 Indian patients admitted with cirrhosis to R. K. Khan and King Edward VIII Hospitals, Durban, between 1977-1981. The commonest presenting feature was swelling of the body followed by pain in the right upper quadrant, most patients had hepatomegaly, jaundice and ascites, and splenomegaly was detected in one-third of cases. Biochemical investigations indicated that most patients had a high globulin and low albumin concentration. Liver function tests revealed raised bilirubin and gamma-glutamyltransferase values in most cases. On histological examination, micronodular cirrhosis predominated (95%) with a high incidence of fat and iron deposition. Changes consistent with alcoholic hepatitis were superimposed in one-third of cases while immunological and viral markers were absent. This study suggests that alcohol is the predominant cause of cirrhosis in Natal Indians.
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PMID:Patterns of cirrhosis in Natal Indians. 320 19

Patients with chronic heart failure (CHF) can often develop such diseases as hepatitis of viral etiology, alcoholic hepatitis, drug affection of the liver and other diseases masked as congestive liver. In most cases CHF concomitant liver diseases have an atypical course with a tendency to a chronic course. CHF is one of the important pathogenetic mechanisms lying in the basis of chronicity of concomitant liver diseases. Refractory CHF, inconsistency of the hemodynamic indices of persistent hepatomegaly must lead a physician to the detection of probable independent liver diseases complicating the syndrome of heart failure. CHF is a factor causing an enhanced fibrosing liver reaction. An important diagnostic test of fibrinogenesis lying in the basis of chronicity of liver diseases, is the determination of enzymatic markers reflecting synthesis and catabolism of the main substance of connective tissue. Change in the levels of haptoglobin, ceruloplasmin and glutamic acid dehydrogenase is an indirect sign of damage of the liver parenchymal endoplasmic reticulum. These indices can serve as differential criteria of the prevalence of cardiovascular disorders in the liver or concomitant independent liver diseases.
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PMID:[Pathogenetic mechanisms of chronicity in liver diseases in patients with circulatory failure]. 361 41

Amiodarone has proved very effective in the treatment of otherwise resistant cardiac tachyarrhythmias. The use of amiodarone has, however, been limited due to its serious side-effects. A patient with cholestatic hepatitis due to amiodarone treatment is presented below and a review of the hepatotoxicity of amiodarone is given. It is concluded that solid evidence exists of hepatic injury due to amiodarone treatment, including steatosis, alterations resembling alcoholic hepatitis, cholestatic hepatitis and micronodular cirrhosis of the liver. Patients receiving amiodarone should be regularly screened with respect to hepatic enzyme levels. Therapy should be discontinued on the suspicion of cholestatic injury or hepatomegaly.
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PMID:Hepatotoxicity of amiodarone. 396 37


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